Art & Science of Writing Forensic Psychological Reports for 0EF/OIF Veterans Applying to be Civilian Police Officers. Ronn Johnson, Ph.D.

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1 Art & Science of Writing Forensic Psychological Reports for 0EF/OIF Veterans Applying to be Civilian Police Officers Ronn Johnson, Ph.D., ABPP

2 Background According to the Committee on the Initial Assessment of Readjustment Needs of Military Personnel, Veterans, and Their Families, OEF and OIF together make up the longest sustained US military operation since the Vietnam War, and they are the first conflicts to depend on allvolunteer military (2010).

3 Risk Factors for OEF/OIF Veterans Mental health concerns Post traumatic stress disorder (PTSD) Major depressive disorder Generalized anxiety disorder Panic disorder Acute Stress Suicidal ideation Substance abuse & addiction Anger control & aggression Traumatic Brain Injury (TBI) & mtbi

4 Risk Factors for OEF/OIF Veterans Readjustment difficulties Difficulty finding & keeping a job Maintaining adequate level of job performance Community involvement Productivity Dangerous driving Marital problems Interpersonal conflict Lower morale

5 Mental Health Outcomes Post-Deployment Estimated 10% of OEF and OIF Army and Marine Corps Service members have a mild TBI 19% of troops returning from Iraq or Afghanistan report mental health problems (only 8.5% report mental health problems when deployed elsewhere) 27% of those deployed 3 or 4 times have been diagnosed with depression, anxiety, or PTSD (the rate is only 12% for those deployed once (Committee on the Initial Assessment of Readjustment Needs of Military Personnel, Veterans, and Their Families, 2010)

6 Mental Health Outcomes Post-Deployment There has been an increase in suicide risk for those OEF and OIF veterans; in 2009, there were 115 confirmed suicides among active duty personnel Increased risk for alcohol abuse, including instances of binge drinking (Committee on the Initial Assessment of Readjustment Needs of Military Personnel, Veterans, and Their Families, 2010)

7 Post-Deployment Readjustment Factors Even for those who have not experienced combat while deployed, many have difficulties readjusting. Sense of isolation Role ambiguity Feelings of powerlessness Boredom Increase the likelihood of the person experiencing psychological distress, depression, or PTSD (Drodge, E.N., & Roy-Cyr, Y., 2003)

8 Pre-Deployment Factors that Contribute to Readjustment Difficulties Pre-deployment or pre-mission stress High levels of work stress prior to deployment Level of personal stress prior to deployment Marital stress prior to deployment (Drodge, E.N., & Roy-Cyr, Y., 2003)

9 Difficulty in Clinical Assessment of Veterans Reluctant to reveal their symptoms May not be able to vocalize problem areas May fear they will be judged or stigmatized May feel pressure to be normal (Katz et al., 2010)

10 Forensic Psychological Assessment I. IACP FFDE and PRE-EMP. STANDARDS II. CAL AND MASS LAWS III. MMPI2-RF, PAI, & 16PF IV. Forensic Interview & Report V. Thinking about the court or appeal hearing testimony

11 Assignment: You have been hired by the CDCR to conduct a forensic eval. on a correctional officer applicant. Reference to relevant State Codes related to psychological screenings Review of background reports Notes to file written by SPB psychologists

12 Evaluation & Report components Personal history questionnaire (PHQ) MMPI2 16PF I-section with "meets" or "does not meet" minimum psychological standards. Calif. law Penal Code 13601(a). Rationale for final recommendation contained in the I-section of your report

13 Calif. Penal Code 13601(a). Using the psychological and screening standards established by SPB or the CDCR shall ensure that, prior to training, each applicant who has otherwise qualified in all physical and other testing requirements to be a peace officer in either a youth or adult correctional facility, is determined to be free from emotional or mental conditions that might adversely affect the exercise of his or her duties and powers as a peace officer.

14 Massachusettes Commonwealth of Massachusetts: Human Resources Division Physician s Guide:Intial-Hire Medical Standards (Effective June 6, 2003) Re: Psychiatric Conditions Medical conditions listed in the Medical Standards are classified as "Category A" or "Category B" conditions. Category A conditions are considered absolutely disqualifying. For Category B conditions you are required to consider whether the particular examinee's condition would prevent him or her from performing the essential functions of the position. (o) Psychiatric 1. Category A medical conditions shall include: a. disorders of behavior, b. anxiety disorders, c. disorders of thought, d. disorders of mood. e. disorders of personality

15 Mass.- Category B 2. Category B medical conditions shall include: a. a history of any psychiatric condition, behavior disorder, or substance abuse problem not covered in Category A. Such history shall be evaluated based on that individual's history, current status, prognosis, and ability to respond to the stressors of the job, b. any other psychiatric condition that results in an individual not being able to perform as a police officer.

16 Why psych. Screening of POs? Pre-employment psych evaluations (PEPEs) do not guarantee the identification of all applicants who may have or subsequently develop psychological problems that could interfere with job performance PEPEs provide relevant info on those aps who may be at higher risk (i.e., inappropriate response in a stressful use of force encounter)

17 Why forensic psychological evaluations for police officers? You Tube of Utah State Trooper 2012 Rodney King Incident LAPD shooting case Two officers shot in Detroit in Police precinct (stress tolerance) Boise police

18 POST Psychological Dimensions 1: SOCIAL COMPETENCE 2: TEAMWORK 3: ADAPTABILITY/FLEXIBILITY 4: CONSCIENTIOUSNESS/DEPENDABILITY 5: IMPULSE CONTROL/ATTENTION TO SAFET 6: INTEGRITY/ETHICS 7: EMOTIONAL REGULATION/STRESS TOLERANCE

19 POST Psychological Dimensions 8: DECISION-MAKING/JUDGMENT 9: ASSERTIVENESS/PERSUASIVENESS 10: AVOIDING SUBSTANCE ABUSE & OTHER RISK-TAKING BEHAVIOR

20 Forensic Psychological Decision making FFDE or other referral ques4ons about the examinee POST Relevant laws, codes, and statutes Specific job tasks Psychological Tes4ng Psychological Interviews Background history reports Polygraph, CSVA, or other integrity checks Conclusary opinions based on all the above info RecommPenal Code 13601(a). enda4ons Johnson, R. (2011). The integration section of forensic psychological evaluation reports in law enforcement: Culturally responsive ending words. In Kiatef, J. (Ed.) (2011) Handbook of Police Psychology. Routledge Academic: New York

21 Why forensic evaluations of peace officers? Employers may be held responsible for the acts of their employees when such acts are performed in the line of duty Monell v. DSS, 1978 U.S. Supreme Ct. municipalities & administrators could be held liable for behavior of subordinates if the subordinate were negligently supervised, trained, or selected.

22 IACP A pre-employment psychological evaluation may include procedures or tests that are not medical in nature (i.e., designed and used to measure personality traits, behaviors, or characteristics such as judgment, stress resilience, anger management, integrity, conscientiousness, teamwork, social competence).

23 POST Psychological Dimensions 1: SOCIAL COMPETENCE 2: TEAMWORK 3: ADAPTABILITY/FLEXIBILITY 4: CONSCIENTIOUSNESS/DEPENDABILITY 5: IMPULSE CONTROL/ATTENTION TO SAFETY 6: INTEGRITY/ETHICS 7: EMOTIONAL REGULATION/STRESS TOLERANCE

24 POST Psychological Dimensions 8: DECISION-MAKING/JUDGMENT 9: ASSERTIVENESS/PERSUASIVENESS 10: AVOIDING SUBSTANCE ABUSE & OTHER RISK-TAKING BEHAVIOR

25 Q & A

26 References Adler, D.A., Possemato, K., Mavandadi, S., Lerner, D., Chang, H., Klaus, J., Tew, J.D., Barrett, D., Ingram, E., & Oslin, D.W. (2011). Psychiatric Status and Work Performance of Veterans of Operations Enduring Freedom and Iraqi Freedom. Psychiatric Services, 62 (1), Arthur, N. (2000). Carer competencies for managing cross-cultural transtitions. Canadian Journal of Counseling, 34 (3), Blevins, D., Roca, J.V., & Spencer, T. (2011). Life guard: evaluation of an ACT-Based workshop to facilitate reintegration of OIF/OEF veterans. Professional Psychology: Research and Practice, 42 (1), Brancu, M., Straits-Troster, K., & Kudler, H. (2011). Behavioral Health Conditions Among Military Personnel and Veterans: Prevalence and Best Practices for Treatment. NCMJ, 72 (1), Briggs, C.A., & Reneson, S. ((2010). Counseling addicted veterans: What to know and how to help. Retrieved from Article_88.pdf Brown, N.D. (2008). Transition from the Afghanistan and Iraqi battlefields to home. AAOHN Journal, 56 (8), Department of Defense. (2008b). U.S. Army wounded warrior program. Retrieved July 15, 2008, from

27 References Hoge, C. W., Castro, C. A., Messer, S. C., McGurk, D., Cotting, D. I., & Koffman, R. L. (2004). Combat duty in Iraq and Afghanistan, mental health problems, and barriers to care. New England Journal of Medicine, 351, Sayer, N.A., Noorbaloochi, S., Frazier, P., Carlson, K., Gravely, A., & Murdoch, M. (2010). Reintergration Problems and Treatment Interests Among Iraq and Afghanistan Combat Veterans Receiving VA Medical Care. Psychiatric Services, 61 (6), Sayer, N.A., Rettmann, N.A., Carlson, K.F., Bernardy, N., Sigford, B.J., Hamblen, J.L., & Friedman, M.J. (2009) Veterans with history of mild traumatic brain injury and posttraumatic stress disorder: challenges from provider perspective. Journal of Rehabilitation Research & Development, 46 (6). Seal, K.H., Metzler, T.J., Gima, K.S., Bertenthal, D., Maguen, S., & Marmar, C. (2009). Trends and Risk Factors for Mental Health Diagnoses Among Iraq and Afghanistan Veterans Using Department of Veterans Affairs Health Care, American Journal of Public Health, 99 (9), Strachan, M., Gros, D.F., Yuen, E., Ruggier, K.J., Foa, E.B., & Acierno, R. (2012). Home-based telehealth to deliver evidence-based psychotherapy in veterans with PTSD. Contemporary Clinical Trials, 33, Straits-Troster, K.A., Brancu, M., Goodale, B., Pacelli, S., Wilmer, C., Simmons, E.M., & Kudler, H. (2011). Developing community capacity to treat post-deployment mental health problems: a public health initiative. Psychological Trauma: Theory, Research, Practice, and Policy, 3(3), Substance Abuse and Mental Health Services Administration. (2012). Behavioral Health Issues Among Afghanistan and Iraq U.S. War Veterans. In Brief, Volume 7, Issue 1. Westwood, M.J., Black, T.G., & McLean, H.B. (2002). A re-entry program for peacekeeping soldiers: promoting personal and career transition. Canadian Journal of Counseling, 36 (3), 2002.

28 References Committee on the Initial Assessment of Readjustment Needs of Military Personnel, Veterans, and Their Families (2010) Returning Home from Iraq and Afghanistan, Washington, DC: Institute of Medicine of the National Academies, Drodge, E.N., Roy-Cyr, Y. (2003) Police peacekeeping: health risks and challenges in a post-conflict environment. International Journal of Police Science, 5:4, Gillan, T. (2001). The correctional officer: one of law enforcement s toughest positions. Corrections Today, 63:6, Katz, L.S., Cojucar, G., Davenport, C.T., Pedram, C., Lindl, C. (2010) Postdeployment readjustment inventory: reliability, validity, and gender differences. Military Psychology, 22: Rothbaum, B.O., Gerardi, M., Bradley, B., & Friedman, M.J. (2011). Evidencebased treatments for posttraumatic stress disorder in operation enduring freedom and operation Iraqi freedom military personnel. In J. Ruzek, P. Schnurr, J. Vasterling, M. Friedman (Eds.) Caring for veterans with deployment-related stress disorders. Washington, DC: American Psychological Association.

Health Care Utilization by Veterans with Posttraumatic Stress Disorder: A Spouse/Intimate Partner Perspective By: Cassandra Buchanan, Nursing

1 Health Care Utilization by Veterans with Posttraumatic Stress Disorder: A Spouse/Intimate Partner Perspective By: Cassandra Buchanan, Nursing 2 Introduction With Operation Iraqi Freedom (OIF) and Operation